Sign Up for Our Living with Asthma Newsletter

Thanks for signing up!

Asthma is a complicated chronic disease that varies among individuals — so that means the treatment often varies, too. To help doctors and nurses know which asthma treatment regimens are best for each person, the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) has written asthma guidelines.

The most recent version, published in 2007, builds on guidelines from 1991, 1997, and 2002 and includes evidence-based recommendations for managing asthma.

How Asthma Guidelines Are Developed

"There’s a science-based committee that’s picked by the NIH for their expertise," says Robert F. Lemanske Jr., MD, head of the Division of Pediatric Allergy, Immunology, and Rheumatology and professor of pediatrics and medicine at the University of Wisconsin School of Medicine and Public Health. Dr. Lemanske, who participated in the guideline development process, says that these working groups develop a draft set of guidelines based on established research and expert input and that the draft then goes through two extensive reviews.

"The purpose of the document is to serve as guidelines for clinicians to better care for and treat asthmatic patients of all ages," says Lemanske.

What Is in the Asthma Guidelines?

Asthma treatments are designed to control asthma. To do that, health care providers need information to help them make decisions about the best asthma treatment protocols for their patients. The guidelines offer this information in four general areas:

Assessment and monitoring. This is important for understanding whether asthma is affecting a person’s quality of life and what effect asthma medications might have on that person's future.

Patient education. Patient education is key to giving people with asthma the ability to manage their disease and to know when to take medication or use other asthma remedies, such as avoiding allergens. If there is one take-away message for all clinicians and patients, it is the importance of an asthma action plan, says Lemanske. "Everybody who has asthma should not leave the doctor’s office without a written asthma management plan in hand so they feel like they know what is going on with their asthma should something happen," he says.

Control of environmental factors that influence asthma. Asthma patients must learn to manage multiple environmental triggers to control their asthma symptoms. The guidelines also include important information about managing related conditions such as gastroesophageal reflux disease, or GERD.

Medication. The asthma guidelines advocate a "stepwise" approach to medication doses and combinations, with a goal of using the least amount of medication necessary to gain control over their asthma symptoms. Based on measures of impairment, clinicians and their patients can decide whether and how to increase medication doses.

"The majority of data would suggest that monotherapy [using only one medication] with low doses of inhaled corticosteroids is really the first line of treatment for all age groups," says Lemanske, but clinicians can use the guidelines to determine which medicines to add when monotherapy is not enough.

There are three major differences between the current asthma guidelines and past guidelines, says Lemanske:

Ages. The guidelines now are directed toward three age groups instead of two. Earlier guidelines were divided into those for younger than age 4 and those for everyone else; now there is a third age range, addressing the specific needs of children between 5 and 11 years old.

Categories. Asthma control is now divided into three categories: well-controlled, poorly controlled, and not controlled.

Impairment and risk. The guidelines use measures of impairment (current functioning) and risk (possible future problems) to make recommendations about asthma remedies. An example of impairment is missing school or work. Examples of risk include medicinal side effects and the possibility of future loss of lung function.

It’s a good idea to take a few minutes to review the guidelines. You’ll learn more about your disease, have more to discuss with your doctor during visits, and ultimately gain more control over your condition. You can look at the guidelines at the NHLBI Web site.

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.